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more than three months into the corona virus pandemic and health care workers on the front lines of the battle against kovat 19 say they still face shortages of personal protective equipment this is Judy shared in Gonzales a nurse at Montefiore hospital in the Bronx one of the city's coronavirus hotspots speaking about the equipment shortage she and her colleagues faced in April 2020 she's also president of the New York State Nurses Association people are freaking out on every single level not to mention can't go home to your family because you're afraid you'd contaminate them you have nowhere to stay some people are staying in hotels sleeping in their cars we're so scared to take off the masks we have to reuse it and you contaminate yourself people are working 18 10 hours without a bathroom break or water just to be safe the personal protective equipment shortage was one of the early flash points of the corona virus pandemic masks ventilators face shields it seemed nearly every kind of personal protective equipment was hard to find when kovat 19 first ripped through epicenters like New York City as the coal bed 1905 in China has subsided we've been able to work to prioritize and allocate more products get approval to bring product from China into the u.s. first of all Ford will be partnering with 3m on the manufacturing or increased manufacturing of n95 respirators it's like being on eBay with 50 other states bidding on a ventilator so how did the medical device shortage happen how did the supply chain fail when it was needed most to understand why the modern supply chain is uniquely vulnerable to a threat like the corona virus we first need to understand how quickly it changed in the last few decades China first joined the World Trade Organization in 2001 the decision was considered a victory for free trade and economic liberalisation China made extensive commitments to reform domestically and reduce trade barriers soon its economy became an integral part of global supply chains when the first coronavirus pandemic known as SARS erupted in 2002 China only represented just more than 4% of worldwide GDP now China represents about 16% of the worldwide GDP an almost four-fold increase the u.s. now depends on China for producing and transporting everything from automotive parts electronics aircraft clothes and yes essential medical gear and supplies so when the novel coronavirus hit China in late December of 2019 it slowed down manufacturing creating a domino effect in supply chains around the world first when you think about the the structure of the system and plays the trade system between United States and China for example even though you might think tend to think of a supply chain is industry specific or company specific when you look at the entire US economy for example it really depends broadly on the inputs from China now I may not source directly from supplier in China but my supplier supplier probably does that's because Western companies found it cheaper to manufacture goods in China rather than to do so closer to home since the SARS outbreak China quickly grew into the second largest economy after the United States according to the World Bank the companies rely on China not simply because it's the lowest cost source of the product but typically its high quality they can count on the delivery and those other factors right so reliable quality delivery on time are equally important this price so China's become an indispensable trading partner to the United States most of the product is you know the US economy is not really an export-driven economy unlike China on my Germany so most of the product is moving from China to the United States either for consumption by consumers or for further manufacturing or integration into products that ultimately are consumed by consumers in this country around the world most personal protective equipment comes from multiple suppliers and contract manufacturers in countries like China Taiwan South Korea Malaysia Thailand and Mexico let's use medical gowns as an example healthcare workers use them to protect themselves from the spread of the infection if they're dealing with people or material that could have been exposed to contagious diseases the raw material fabrics used to create the gowns are typically sourced from China according to Susan Devore the CEO of healthcare company premier the fabrics get shipped to a contract manufacturer in China Cambodia or Vietnam that's where the gowns get stitched together and assembled once done the products get sent to the United States on large cargo ships through ocean shipping lanes when the cargo arrives on US soil it must go through customs then the products get shipped to the manufacturer that owns the actual gown company and then the gowns get sent to distribution centers across the country the process from requesting the order to getting the finished product takes about 90 days according to Devore and these are products that cost about less than one dollar per item divorce said because of the corona virus outbreak in Wuhan manufacturers couldn't get any raw materials out of China for several weeks that means assembly came to a stop and that means no new products got shipped overseas by the time the novel coronavirus came ashore in the United States in March of 2020 the supply chain linking the world's two largest economies was already in disarray there are a lot of exposures and I actually think they're coming in waves the first wave was the diagnostic testing kits and swabs the next wave was the masks and gowns and protective apparel and equipment the next wave is it is going to be Pharma because a lot of the pharmaceuticals and the active ingredients come from other countries in the world and so I think because this demand really has no limit it has exposed I think challenges in the supply chain many of which couldn't have been predicted but we have known for a long time that we are too dependent on other countries in the world for our core medical supplies strict regulations by the FDA also contributed to the shortage we have a unique situation where one of the manufacturers of healthcare gowns or a protective gowns for health care workers switch suppliers in China and that supplier had not been approved by the FDA FDA now everything that touches the human body has to be approved by the FDA so you can't radically care quickly switch suppliers in a heavily healthcare regulated context like you can and some other industry sectors so we have a shortage of gowns because we had to find the supplier that was qualified right in order to do that then you've got a compounding factor that much of this equipment moves to healthcare systems through distributors big companies like cardinal and McKesson so they've become bottlenecks they're experiencing shortages in terms of getting supply then that in turn impacts their own customers in the response to the medical device shortage president Trump invoked the defense production act a law from the 1950s to compel companies to produce face masks and ventilators the order directed six companies General Electric Hill ROM Holdings Medtronic ResMed Royal Philips and V and V air medical to make ventilators but a majority of these companies were already producing ventilators before the order was put in place to help with the shortage other corporations also stepped up to produce medical supplies to address the global shortage Apple announced it would produced 1 million face shields per week for medical workers after it donated 20 million and 95 masks to organizations GM offered to give manufacturing blueprints for face masks to 600 auto parts suppliers after it revamped its factories to produce tens of thousands of ventilators Tesla unveiled a coronavirus ventilator prototype that uses the model 3 parts after a donated ventilators from China retail stores like Ralph Lauren pledged more than 250,000 masks in 25,000 isolation gowns Canada Goose said it would produce 10,000 scrubs and patient gowns gap Zara L'Oreal and LVMH are all working to produce hand sanitizers medical masks hospital gowns and protective supplies in new york city health officials plan to develop their own medical device stockpile to help deal with future pandemics another factor that adds to the confusion and panic is how the healthcare industry is structured in the US the fact that we have a for-profit system so everything is geared not so much to protecting the public's health but toward generating profit Healthcare should not be built that way because there's no profit made in preparing for disasters that is not a profitable not a profitable practice we found this after 9/11 we found it after Hurricane sandy and we see it again and again after pandemics and other kinds of disasters so without that infrastructure developed without the public health infrastructure you're always going to be playing catch-up because you don't you don't have that capability the supply chain problems that surfaced during the corona virus pandemic exposed just how much of the US economy relied on overseas manufacturing it's the same problem cited by President Trump and trade Hawks like Peter Navarro during the us-china trade work months before the novel coronavirus first popped up and now it seems a global pandemic not the trade war between the US and China is pushing American companies to look at bringing the supply chain back home and there's an argument now for the latter more companies seriously thinking about relocating their plants back in the United States and the reason for that is in part because number one you know the core the labor costs in China have got up the cost of transporting goods on cargo ships across the Pacific have gone up and here in the United States we know we've made some real advances and technology that could help reduce production costs and maybe even rely less on labor to produce some of the goods that we've relied on so much coming in from China so I think you without a doubt there are gonna be some major changes on the supply chain route we're also gonna be seeing I think a lot of casualties among US companies particularly among the airlines and farmers the shale oil industry a lot of casualties and also a lot of consolidation among those industries too but definitely anticipating that companies will look at maybe nearby locations and possibly even some other locations Eastern Europe northern Mexico possibly India those are the geographies that could benefit from kind of us a second look at the viability as a secondary source of suppliers Peter Navarro one of trumps economic advisors pledged that the US would move away from its reliance on foreign nations and build its own capabilities to produce drugs and medical supplies and America is going to need a lot of jobs to bounce back from the economic devastation caused by widespread coronavirus lockdowns we're going to see permanent changes lasting changes transformative changes in the entire business and economic landscape there's going to be a dramatic reassessment of supply chains can we still rely if not on China on other Asian countries or should we now try to figure out whether the economics have so changed that it makes more sense to produce in the United States you [Music]